Treatment endoscope

ABSTRACT

In a treatment endoscope which includes: an elongated insertion section having a first channel for inserting a treatment instrument therethrough; an arm, having a second channel for inserting a treatment instrument therethrough, attached to the distal end of the insertion section so that the first channel communicates with the second channel; a first operation section for operating the arm; and a second operation section for operating the insertion section, the arm has a first bending section which can be operated to be bent via the first operation section, the insertion section has a second bending section which can be operated to be bent via the second operation section, and an interlock mechanism connects the first operation section to the second operation section so that, when either one of the first bending section and the second bending section is bent by operating either one of the first operation section and the second operation section, the other one of the first bending section and the second bending section bends.

CROSS REFERENCE TO RELATED APPLICATIONS

This is a Continuation In-part Application (CIP) based on U.S. patentapplication Ser. No. 12/057,990, titled “MEDICAL APPARATUS”, filed Mar.28, 2008, which is a CIP based on U.S. patent application Ser. No.12/035,535, titled “MEDICAL TREATMENT ENDOSCOPE”, filed Feb. 22, 2008,which is a CIP based on U.S. patent application Ser. No. 11/809,488,titled “MEDICAL TREATMENT ENDOSCOPE”, filed Jun. 1, 2007, which is a CIPbased on U.S. patent application Ser. No. 11/652,880, titled “MEDICALTREATMENT ENDOSCOPE”, filed Jan. 12, 2007, which is a CIP based on U.S.patent application Ser. No. 11/435,183, titled “MEDICAL TREATMENTENDOSCOPE”, filed May 16, 2006, which is a CIP based on U.S. patentapplication Ser. No. 11/331,963, titled “MEDICAL TREATMENT ENDOSCOPE”,filed Jan. 13, 2006.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a treatment endoscope having atreatment instrument inserted into an arm section which is provided atthe distal end of an insertion section and operated to conducttreatment.

2. Background Art

Laparoscopic surgery is a known technique for conducting medicalactivities including observation of or treatment for the organs of humanbody, and this technique provides manipulation by making a plurality ofopenings on the gastric wall and inserting a treatment instrument suchas laparoscopy or forceps, etc. into each opening instead of making alarge abdominal incision. This type of surgery is advantageous becausethe mere formation of small openings on the gastric wall can reducestress imposed on a patient.

As a method of even further reducing stress on the patient, it has beenproposed in recent years to carry out manipulations by inserting aflexible endoscope into the patient via a natural opening such as themouth, nostrils or anus. An example of a medical treatment endoscopeused in such procedures is disclosed in U.S. Patent ApplicationPublication No. 2005/0065397.

In the medical treatment endoscope disclosed in this reference, armmembers that have a bendable end are respectively inserted into aplurality of lumens disposed within a flexible inserted part that isinserted into the body via the mouth of the patient. By insertingrespective instruments through these arm members, the procedure site canbe approached from different directions with the various instruments.Accordingly, a plurality of procedures can be carried out in continuumby means of a single endoscope inserted into the body.

SUMMARY OF THE INVENTION

A first aspect of the present invention is a treatment endoscope whichincludes: an elongated insertion section having a first channel forinserting a treatment instrument therethrough; an arm, having a secondchannel for inserting a treatment instrument therethrough, attached tothe distal end of the insertion section so that the first channelcommunicates with the second channel; a first operation section foroperating the arm; and a second operation section for operating theinsertion section, so that the arm has a first bending section which canbe operated to be bent via the first operation section, the insertionsection has a second bending section which can be operated to be bentvia the second operation section, and an interlock mechanism connectsthe first operation section to the second operation section so that,when either one of the first bending section and the second bendingsection is bent by operating either one of the first operation sectionand the second operation section, the other one of the first bendingsection and the second bending section bends.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 shows the configuration of a treatment endoscope according to afirst embodiment of the present invention.

FIG. 2 shows the structure of transmitting the endoscope's operation.

FIG. 3 shows the movement of an arm section of the treatment endoscopewhen used.

FIG. 4 shows the movement of an arm section of the endoscope when used.

FIG. 5 shows a first operation shaft of the treatment endoscopeaccording to a second embodiment of the present invention in afragmentary sectional view.

FIG. 6 shows the initial state of the first operation shaft.

FIG. 7 shows the movement of the arm section of the treatment endoscopewhen used.

FIG. 8 shows the movement of the arm section of the treatment endoscopewhen used.

FIG. 9 shows the movement of the arm section of the treatment endoscopewhen used.

FIG. 10 illustrates the first operation shaft when linked movement isstarted.

FIG. 11 is a view showing a modified example of treatment endoscopeaccording to the embodiment.

FIG. 12 is an isometric view of an operation stick of the firstoperation section of the treatment endoscope according to the secondembodiment of the present invention.

FIG. 13 is an isometric view of a channel unit inserted into theoperation stick.

FIG. 14 is an isometric view of the first operation section covered witha cover.

FIG. 15 shows a second operation section maintained by the cover

FIG. 16 is an isometric view showing an opening state of the frontsurface of the cover.

FIG. 17 shows the vicinity of the rear surface of the cover.

FIG. 18A is an isometric view of a modified example of the distal end ofthe insertion section of the treatment endoscope according to thepresent invention.

FIG. 18B shows a visual field of an observation device of the treatmentendoscope.

FIG. 19A shows an example of manipulation using the treatment endoscope.

FIG. 19B shows a visual field of the observation device of the treatmentendoscope shown in FIG. 19A.

PREFERRED EMBODIMENTS

A first embodiment of the present invention will be explained as followswith reference to FIGS. 1 to 4. FIG. 1 shows the configuration of atreatment endoscope 1 according to the present embodiment.

The treatment endoscope 1 includes an insertion section 2 inserted intoa body cavity; an arm section 3 provided at the distal end of theinsertion section 2; a first operation section 4 for operating the armsection 3; and a second operation section 5 for operating the insertionsection 2.

The flexible and elongated insertion section 2 has an operation channel(first channel), not shown in drawings, for inserting a treatmentinstrument therethrough. The insertion section 2 has a bending section(second bending section) 6 having a commonly known structure. Aplurality of substantially cylindrical connected joint rings, not shownin the drawings, are aligned in an axial line direction. In addition,wires (transmission members), not shown in the drawings, facing witheach other and having the axial line of the joint rings therebetween areinserted into the joint rings and attached thereto. Operating the secondoperation section 5 allows the wires connected to the second operationsection 5 to bend a bending section 6. An observation device, not shownin the drawings, attached to the distal end of the insertion section 2and movable distally and proximally in a predetermined range permitsobservation of, for example, a treatment site in the body cavity or ofthe arm section 3.

The arm section 3 has two arms 3A and 3B each having a channel (secondchannel) which allows a treatment instrument to pass therethrough. Eachchannel of the arms 3A and 3B communicates with the operation channel ofthe insertion section 2.

The arms 3A and 3B have first bending sections 7A and 7B and secondbending sections 8A and 8B. The second bending sections 8A and 8B areprovided proximally relative to the first bending sections 7A and 7B.

A plurality of substantially cylindrical joint rings 9 aligned in anaxial line direction are connected to the first bending sections 7A and7B similarly to the bending section 6. In addition, two pairs of twowires (transmission members), not shown in the drawings, facing eachother and having the axial line of the joint rings 9 therebetween areattached so that the phase of the two pairs of wires is shifted by 90degrees on the joint rings 9. Operating appropriately, i.e., retractingthe four wires connected to the first operation section 4 appropriatelyallows the arms 3A and 3B to bend in four directions. It should be notedthat two directions of the four directions are parallel with a planedefined by the arms 3A and 3B and parallel with one of swingingdirections of the bending section 6. This direction indicates the“horizontal direction” in the following explanations.

The second bending sections 8A and 8B are mechanisms capable of bendingand fixing to facilitate operation, which will be explained later, ofthe treatment instruments inserted through the arms 3A and 3B so thatthe distance of the axial lines of the arms 3A and 3B attachedsubstantially in parallel increases more significantly than the distanceshown in FIG. 1. Substantially similar to the first bending sections 7Aand 7B, each of the second bending sections 8A and SB is provided withjoint rings and wires. The second bending sections 8A and SB can be bentand fixed by retracting the wires. The wires extending from the firstbending sections 7A and 7B and the second bending sections 8A and SBfurther extend to the first operation section 4 through the link sheath10.

The first operation section 4 for operating the arms 3A and 3B of thearm section 3 is provided with a first operation unit 11 for operatingthe arm 3A and a second operation unit 12 for operating the arm 3B.

Operation sticks 13A and 13B operated by a user are attached to theoperation units 11 and 12 respectively. The operating sticks 13A and 13Bwhich have the same structure have a channel for inserting the treatmentinstrument therethrough. Each channel is connected to a forceps port 14provided in the vicinity of the proximal end of the insertion section 2through, for example, a tube not shown in the drawings, and communicateswith the operation channel, not shown in the drawings, in the insertionsection 2.

The operation sticks 13A and 13B has first operation shafts 15A, and 15Band second operation shafts 16A and 16B, respectively attached thereto.The first operation shafts 15A and 15B make rotation interlocked withvertical operation conducted by using the operation sticks 13A and 13B.The second operation shafts 16A and 16B make rotation interlocked withhorizontal operation conducted by using the operation sticks 13A and13B. The wires extending through the link sheath 10 for operating thefirst bending sections 7A and 7B are attached to the first operationshafts 15A and 15B, and to the second operation shafts 16A and 16B ofthe operation units 11 and 12 respectively. In addition, the wire, notshown in the drawings, for operating the second bending sections 8A and8B are connected to a slider 18 provided to each of the operation sticks13A and 13B. The wires can be retracted by drawing the slider 18proximally.

The second operation section 5 has an angle knob 17. The bending section6 can be bent by operation to rotate the angle knob 17.

FIG. 2 shows the structure of transmitting the operation of thetreatment endoscope 1. A pulley (first operation member) 19 is attachedto the second operation shafts 16A and 16B coaxially, of the firstoperation section 4 (FIG. 2 shows only the second operation shaft 16A).The proximal ends of a pair of wires 20A and 20B connected to the firstbending section 7A are connected to the outer periphery of the pulley19. In addition, a pulley (second operation member) 22 is attachedcoaxially to a third operation shaft 21 having the angle knob 17 of thesecond operation section 5 attached thereto. A pair of wires 23A and 23Bconnected to the bending section 6 are connected to the outer peripheryof the pulley 22.

Link pulleys 24A and 24B are attached to the second operation shaft 16Aand the third operation shaft 21 respectively and coaxially. The linkpulleys 24A and 24B are connected by a link wire 25. Therefore,rotational operation of one of the second operation shaft 16A and thethird operation shaft 21 causes the link pulleys 24A and 24B and thelink wire 25 to be operable as a interlock mechanism, and the other oneis interlocked and rotated in the same direction.

Operations in using the treatment endoscope 1 having the previouslyexplained configuration will be explained.

In the beginning, a user inserts the insertion section 2 of thetreatment endoscope 1 into the body cavity of for example, a patient.During the insertion, the inserted state of second bending sections 8Aand 8B of the arms 3A and 3B of the arm section 3 is not bent, i.e., thesecond bending sections 8A and 8B are maintained in a substantialstraight line. Each wire for operating the arm section 3 and theinsertion section 2 can be inserted smoothly since the connected wireshaving slack in some degree can follow the serpentine path, etc. in thebody cavity flexibly.

Upon reaching the arm section 3 to the vicinity of a treatment objecttissue, the user inserts treatment instruments used with the operationsticks 13A and 13B of the first operation section 4, and projects thetreatment instruments from the distal ends of the arm section 3 throughthe channels of the insertion section 2. Subsequently, drawing thesliders 18 of the operation sticks proximally, that is, toward thehandling side causes the wires connected to the second bending sections8A and 8B to be retracted, thereby bending the arms 3A and 3B and fixingso that the distance of the axial lines of the arms 3A and 3B increasesas shown in FIG. 1.

The user conducts manipulation by moving the operation sticks 13A and13B vertically and horizontally while observing the object tissue andthe arm section 3 with an observation device, and moving the arms 3A and3B each having the treatment instrument projecting therefrom intodesirable directions.

FIG. 3 shows an operation of retracting an object tissue T with the armsection 3. The drawing shows only the right-hand side of arm 3A torender the drawing more legible. In the event that the user grasps theobject tissue T with the distal ends of a treatment instrument 100 andretracts the grasped object tissue T in a left-hand direction in FIG. 3,the operation stick 13A attached to the first operation unit 11 of thefirst operation section 4 is rotated in a counterclockwise direction.Subsequently, the second operation shaft 16A is rotated and the wiresconnected to the first bending section 7A are retracted, andaccordingly, the first bending section 7A of the arm 3A bends in theleft-hand direction as shown in FIG. 4. The link pulley 24A attached tothe second operation shaft 16A rotates in the same direction inaccordance with the bending of the first bending section 7A. Themovement of the link pulley 24A is also transferred to the link pulley24B attached to the second operation section 5 through the link wire 25.This causes the pulley 22 of the second operation section 5 to rotateand causes the wires connected to the bending section 6 to be retracted,thereby causing the bending section 6 to bend in the same direction asthat of the first bending section 7A as shown in FIG. 4.

The reaction force produced by retracting the tissue T acts on the firstbending section 7A and the bending section 6 of the insertion section 2.Therefore, in some case using a conventional treatment endoscope, it isdifficult to retract the tissue T significantly because the bendingsections failing to endure the reaction force inevitably bend in thedirection opposite the first bending section (the right-hand directionin this case). However, according to the treatment endoscope 1 of thepresent embodiment, the bending section 6 of the insertion section 2interlocked with the first bending section and bending in the samedirection can endure the bending caused by the reaction force.Therefore, the treatment object tissue can be retracted with asignificant force because the insertion section 2 endures the reactionforce produced by retracting the insertion section 2

A second embodiment of the present invention will be explained next withreference to FIGS. 5 to 11. A treatment endoscope 31 according to thepresent embodiment is different from the previously explained treatmentendoscope 1 because a first operation section and a second operationsection are interlocked when a predetermined degree of operation isprovided. It should be noted that configurations that are equivalent tothose of the previously explained first embodiment will be assigned thesame numeric symbol and redundant explanation thereof will be omitted.

FIG. 5 shows a second operation shaft 32 of the treatment endoscope 31in fragmentary sectional view. The second operation shaft 32 is fixed tothe pulley 19 for operating the first bending section of an armcoaxially and unitarily. A link shaft 34 having a link pulley 33attached thereto is inserted into the pulley 19 rotatably and furtherinserted into a recession section 32A provided in the second operationshaft 32.

A plurality of substantial cylindrical grooves 34A are formed on theouter periphery of the link shaft 34. A pin 35 urged to project in theaxial line thereof is provided in the link pulley 33. The link pulley 33is locked to the link shaft 34 by fitting the pin 35 into the grooves34A.

A spring 36 placed between the pulley 19 and the link pulley 33 urgesthe pulley 19 and the link pulley 33 so that the distance therebetweenincreases.

A cam groove 34B is formed on the outer periphery in the vicinity of thelower end of the link shaft 34. In addition, a pin 37 attached to thesecond operation shaft 32 and projecting into the recession section 32Aengages with the cam groove 34B. The pin 37 and the cam groove 34B areadjusted so that the pin 37 engages with the cam groove 34B at theposition most close to the lower end of the link shaft 34 in the initialstate, i.e. in the straight state of the first bending section of an armas shown in FIG. 6.

Operation of the treatment endoscope 31 having the previously explainedconfiguration will be explained with reference to an example using thearm 3A.

In the event of retraction, etc. of the tissue T, the user in thebeginning grasps the object tissue T with the distal ends of thetreatment instrument 100 projecting from the arm 3A as shown in FIG. 7.Subsequently, the first bending section 7A is bent by rotating or movingthe operation stick 13A.

The link pulley 33 in this state does not start movement linked with thepulley 19 because the spring separates the pulley 19 of the secondoperation shaft 32 from the link pulley 33. However, when the secondoperation shaft 32 is rotated by rotating or moving the operation stick13A, the pin 37 attached to the second operation shaft 32 upon makingcontact with the oblique surface of the cam groove 34B of the link shaft34 moves in the cam groove 34B so that the pin 37 approaches the linkpulley 33 gradually. Accordingly the link shaft 34 resisting the urgingforce of the spring 36 moves downward gradually, and then, the linkpulley 33 approaches the pulley 19. In this process, only the arm 3Abends as shown in FIG. 8 while the bending section 6 of the insertionsection 2 does not start to bend yet.

Further rotating or moving the operation stick 13A causes a bottomsurface 33A of the link pulley 33 to make contact with the pulley 19 asshown in FIG. 10. Subsequently, the pulley 19 is fixed to the linkpulley 33 by the mutual friction force, and then, the pulley 19 and thelink pulley 33 rotate in one unit. After this point in time, the firstbending section 7A starts moving linked with the bending section 6 ofthe insertion section 2, and the bending section 6 of the insertionsection 2 bends in addition to the bending of the arm 3A as shown inFIG. 9; therefore, the shape of the insertion section 2 is maintained,and a retractive operation with a more significant stroke can beconducted.

The timing of starting the movement of the pulley 19 linked with thelink pulley 33 can be adjusted within a fixed range by changing theclearance between the pulley 19 and the link pulley 33. The user, in anattempt to change the clearance, may change the position of the pin 35engaging with the grooves 34A of the link shaft 34 by operating the pin35 of the link pulley 33. That is, the pin 35 and the grooves 34A areoperable as an adjusting mechanism for adjusting the operation degreewhich is necessary for the linked movement.

The treatment endoscope 31 according to the present embodiment canobtain the same effect as that of the treatment endoscope 1 according tothe first embodiment. Also, a more desirably operable treatmentendoscope can be configured by adjusting so that a relatively smallbending operation, for example, a mere tissue grasping operation or adissectional operation does not make a linked movement, and so that thebending section 6 of the insertion section 2 moves to link with themovement of the first bending section of the arm section 3 in arelatively large bending operation, for example, tissue retraction,because one of the operation sections 4 and 5 must be operated by atleast a constant degree until the bending section 6 and the firstbending section start linked movement.

In place of the aforementioned embodiment which has been explained withreference to the example in which the arm section makes movement linkedwith the bending section by at least a fixed operation degreeirrespective of the bending direction, a treatment endoscope may beconfigured so that the bending movement of the arm section linked withthe bending section is limited in an arbitrary direction. The followingis an example.

FIG. 11 shows a treatment endoscope 31A as a modified example of thepresent embodiment. When viewed from the proximal end, an obliquesurface is provided on a left-hand region of a cam groove 39B of a linkshaft 39 inserted into a second operation shaft 38A of the firstoperation unit 11 for operating the arm 3A shown on the right-hand sideof the drawing. On the other hand, when viewed from the proximal end, anoblique surface is provided on a right-hand region of a cam groove 40Bof a link shaft 40 inserted into a second operation shaft 38B of thesecond operation unit 12 for operating the arm 3A shown on the left-handside of the drawing.

Therefore, the bending section 6 of the insertion section 2 makes linkedmovement only when the right-hand arm 3A bends in right-hand directionsand only when the left-hand arm 3B bends in left-hand directions. Aninterlock mechanism having the aforementioned configuration can achievethe object desirably since, in many cases operations, e.g., retractionwhich needs interlocked movement, are conducted while one arm is bentand separate from the other arm.

Next, a third embodiment of the present invention will be explained withreference to FIGS. 12 to 17. The treatment endoscope of the presentembodiment is different from the treatment endoscope 1 according to theaforementioned first embodiment based on the structure of a firstoperation section. It should be noted that configurations that areequivalent to those of the previously explained first embodiment will beassigned the same numeric symbol and redundant explanations thereof willbe omitted.

FIG. 12 is an isometric view of an operation stick 52 attached to thefirst operation section of a treatment endoscope 51 according to thepresent embodiment. The operation stick 52 having substantially the samestructure as that disclosed in U.S. patent application Ser. No.12/057,990 has a channel unit 53 inserted therethrough detachably asshown in FIG. 13.

The lumen of the channel unit 53 is a channel for allowing a treatmentinstrument to pass therethrough and to project from the distal ends ofthe arm section 3. The channel unit 53, except for a part thereof isfully made of stainless steel SUS303 for reuse by conducting cleaning orautoclave sterilization, etc. Stainless steel SUS304 may be used inplace of stainless steel SUS303.

A first cap 54 and a second cap 55 for sealing the two ends of thechannel and maintaining a sterilized condition in the channel prior tothe usage thereof are attached to the channel unit 53. Prior to usingthe treatment endoscope 51, the channel unit 53 is inserted into theoperation stick 52, and the caps 54 and 55 are removed.

A first operation section 56 having two operation sticks 52 attachedthereto is fully covered with a cover 57 as shown in FIG. 14. It shouldbe noted that FIG. 14 omits a first operation shaft and a secondoperation shaft to render the drawing more legible.

An opening 59 is formed on a front surface 58 of the cover 57 positioneddistally relative to the first operation section 56. The distal end ofeach channel unit 53 inserted through the operation stick 52 projectsfrom the opening 59. A treatment-instrument channel in the insertionsection 2 (not shown in the drawing) communicates with the channelformed in the channel unit 53 via a connecting section 60 provided tothe distal end of the channel unit 53.

A shutter 61 capable of sliding in a vertical direction is attached tothe opening 59. This configuration which does not prevent the movementof the distal end section of the channel unit 53 including theconnecting section 60 and shields the opening 59 as much as possible canreliably maintain hygienic condition.

The distal end section of a stage 62 formed substantially parallel withthe distal end section of the channel unit 53 projects ahead of theopening 59. The structure of the stage 62 will be later explained indetail. Since the connecting section 60 is disposed on the stage 62, theuser can conduct smooth operations by smoothly moving the connectingsection 60 on the stage 62.

Holder bases 63 are attached unitarily on two areas lateral to theopening 59 of the front surface 58. A holder 64 for holding the secondoperation section 5 is attached to each holder base 63 as shown in FIG.15. Each holder 64 is detachable and capable of moving along the holderbase 63 in a fixed range. The holder 64 can be mounted to the holderbase 63 over a drape which covers the cover 57 fully surrounding thefirst operation section 56 for the sake of pollution prevention asdisclosed in the U.S. patent application Ser. No. 12/057,990.

FIG. 16 shows the open state of the front surface 58. The front surface58 capable of freely opening and closing is connected to the otherportion of the cover 57 detachably by hinges 58A provided to the uppersection of the front surface 58. In addition, each hinge 58A having acommonly known lock mechanism, which is not shown in the drawings, isconfigured to be unoperable unless a predetermined value of force isapplied in a closed state as shown in FIG. 14 and in an opened state asshown in FIG. 16. Therefore, even if the cover 57 leans, it does notclose by the self weight of front surface 58, and the front surface 58is prevented inadvertently from opening from the closed state of thefront surface 58.

The stage 62 has a first stage 62A projecting from the opening 59; asecond stage 62B provided proximally relative to the first state 62A; abulkhead 62C provided in the middle in the width direction of the secondstage 62B; and a connecting stage 62D for steplessly connecting thefirst stage 62A to the second stage 62B. According to the aforementionedconfiguration, the distal end section of the channel unit 53, which isinserted into the operation stick 52 and includes the connecting section60, projects from the distal end of the operation stick 52 and fatherprojects above the second stage 62B. Subsequently, the distal endsections upon moving ahead (distally) while sliding on the second stage62B are guided by the bulkhead 62C and the connecting stage 62D, andmoves onto the first stage 62A smoothly and automatically withoutintersecting as shown in FIG. 16. In the unlikely event that, forexample, the distal end section falls off from above the stage 62 in thecover 57, the user can grasp the distal end section directly by openingthe front surface 58 and dispose the distal end section on the firststage 62A.

FIG. 17 shows a rear surface 65 of the cover 57 disposed proximallyrelative to the first operation section 56. Two openings 66 are providedon the rear surface 65. The proximal end of the operation stick 52having the channel unit 53 inserted therethrough projects from eachopening 66.

A boot 67 made of an elastic material, e.g., rubber, is attached to eachopening 66. The boot 67 includes an outer layer 68 having a substantialfour-sided pyramid shape; and a substantially cylindrical inner layer69. A periphery 68A disposed proximally relative to the outer layer 68is attached to a periphery 66A of the opening 66 unitarily. The innerlayer 69 covers the external surface of the operation stick 52 and thevicinity of a swinging center to which the first operation shaft and thesecond operation shaft are attached. The distal end section of the innerlayer 69 is joined to the distal end section of the outer layer 68.Consequently, the user is prevented from touching each mechanism of thefirst operation section 56 contained in the cover 57 since the opening66 is sealed by an inner surface 68B of the outer layer 68 and an outersurface 69A of the inner layer 69.

The treatment endoscope 51 according to the present embodiment canobtain the same effect as that of the treatment endoscope according tothe aforementioned each embodiment.

Also, the cover 57 covering the first operation section 56 can hold thesecond operation section 5 for operating the insertion section 2 via theholder base 63 and the holder 64. Therefore, a more facilitatedone-person operation can be provided to the user who operates the firstoperation section 56 and the second operation section 5.

Furthermore, pollution caused by the user who touches each mechanism ofthe first operation section 56 in the cover 57 can be desirablyprevented since the opening 66 of the rear surface 65 of the cover 57 issealed by the boot 67.

Also, the easily deformable elastic boot 67 made of a a material havingflexibility does not prevent the vertical and horizontal swingingoperations of each operation stick 52 along with the operation.Therefore, the user can conduct an operation smoothly.

In addition, although the sealing section of each opening 66 has bumpyportions and recessed portions, each opening 66 free from fine complexshape is formed to have many flat or smooth sections since each opening66 sealed by two surfaces including the inner surface 68B of the outerlayer 68 of the boot 67 and the outer surface 69A of the inner layer 69.Therefore, the sealing section can be cleaned easily, and themaintenance capability can be enhanced.

Although the present invention has been described with respect to itspreferred embodiments, the present invention is not limited to theembodiments described above. The configuration of the present inventionallows for addition, omission, substitution and further modificationwithout departing from the spirit and scope of the present invention.

For example, the aforementioned each embodiment explained with referenceto the example in which the first operation section and the secondoperation section makes linked movements when either one of them isoperated can be replaced by an endoscope having a configuration in whicha commonly known one-way clutch is attached to one of the two componentsso that the two components make linked movements only when thepredetermined first operation section or the second operation section isoperated. This can provide a treatment endoscope having a configurationcapable of corresponding to more complex operations.

Also, the aforementioned each embodiment explained with reference to theexample in which the arm section 3 and the insertion section 2 makelinked bending movements by operating the two laterally aligned arms ofthe arm section can be replaced by a treatment endoscope having aconfiguration in which, the two components make bending movements linkedwith bending movement in other directions, for example, in therising-and-falling direction relative to FIG. 11.

The linked bending directions of the arm section and the insertionsection may be set desirably in accordance with manipulation conductedto a treatment site. It should be noted that treatment, etc. can beprogressed while changing the direction of linked movement in accordancewith the detail of manipulation by rendering the interlock mechanismincluding the link pulleys and the link wires freely detachable withrespect to each operation shaft.

Furthermore, the aforementioned embodiments explained with reference tothe example in which the interlock mechanism uses wires and link pulleysin configuration can be replaced by other commonly known configurations,for example, using chains and sprockets that makes linked movements, ora rack-and-pinion mechanism in which the proximal ends of wires arefixed to a rack to make linked movements.

In addition, the number of arms is not limited specifically to theaforementioned each embodiment explained with reference to the examplein which two arms are attached to the distal end of the insertionsection. That is, the arm may be in a single piece, or in three or morepieces. Also, the insertion section and the arm may not have anoperation channel, and a treatment mechanism such as a grasping forcepsmay be attached to the distal end of the arm.

Also, an observation device 72 in an initial state attached to thedistal end of the insertion section may be positioned below the two armsections 3A and 3B similarly to a treatment endoscope 71 according to amodified example shown in FIG. 18A. In this configuration, the proximalend of the arm section 3 can be projected in the upper region of avisual field in the observation device 72 as shown in FIG. 18B. Thetreatment site and the distal end of the treatment instrument 100projecting from the arm section 3 can be observed more desirably in theaforementioned modified example in contrast to uneasy observation for atreatment site, etc. with a conventional observation device positionedabove the arm sections 3A and 3B and increasing the ratio of the imageof the arm sections to the visual field of the observation device.

Furthermore, the user conducts manipulation to a treatment-object siteT1 existing below a non-treatment-object site T2 as shown in FIG. 19A,which is not treated, by sinking the insertion section 2 under thenon-treatment-object site T2, raising the non-treatment-object site T2by operating the arm section 3, and rendering the treatment-object siteT1 observable.

FIG. 19B shows the visual field in the observation device 72 obtained bypushing the non-treatment-object site T2 upwardly with the arm section3. The visual field is not blocked since the non-treatment-object siteT2 is positioned above the arm section 3; therefore, thetreatment-object site T1 can be observed desirably since the arm section3 is positioned upward. Consequently, the user can conduct manipulationeasily. In the conventional case in which the observation device isdisposed above the arm section, the arm section must be raised above theobservation device to push the non-treatment-object site T2 above theobservation device. However, it is difficult to conduct manipulationwhile maintaining such state.

The present invention is not limited to the above descriptions but islimited only by the appended claims.

1. A treatment endoscope, comprising: an elongated insertion section having a first channel for inserting a treatment instrument therethrough; an arm, having a second channel for inserting a treatment instrument therethrough, attached to the distal end of the insertion section so that the first channel communicates with the second channel; a first operation section for operating the arm; and a second operation section for operating the insertion section, wherein the arm has a first bending section which can be bent via the first operation section, the insertion section has a second bending section which can be bent via the second operation section, and an interlock mechanism connects the first operation section to the second operation section so that, when either one of the first bending section and the second bending section is bent by operating either one of the first operation section and the second operation section, the other one of the first bending section and the second bending section bends.
 2. A treatment endoscope, comprising: an elongated insertion section having a first channel for inserting a treatment instrument therethrough; an arm, having a second channel for inserting a treatment instrument therethrough, attached to the distal end of the insertion section so that the first channel communicates with the second channel; a first operation section for operating the arm; and a second operation section for operating the insertion section, wherein the arm has a first bending section which can be bent via the first operation section, the insertion section has a second bending section which can be bent via the second operation section, and an interlock mechanism connects the first operation section to the second operation section so that, when the first bending section is bent by operating the first operation section, the second bending section makes linked bending movement.
 3. The treatment endoscope according to claim 2, further comprising a clutch mechanism preventing the operation by the second operation section from being transferred to the first operation section.
 4. The treatment endoscope according to claim 1, wherein the first operation section and the second operation section start linked movements when one of the first operation section and the second operation section is operated by a predetermined or more degree.
 5. The treatment endoscope according to claim 4, further comprising an adjusting mechanism for adjusting the predetermined degree.
 6. The endoscopic treatment instrument according to claim 4, wherein the first operation section has a first operation member having a transfer member connected to the first bending section, the second operation section has a second operation member having a transfer member connected to the second bending section, and when one of the first operation section and the second operation section is operated by a predetermined degree, the interlock mechanism, upon making contact with the first operation member and the second operation member, causes the first operation section and the second operation section to make linked movements. 